22-024 (5) BP-2024-1094
38 SPRUCE HILL AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
22-024-001 CITY OF NORTHAMPTON
Permit: Exterior Res
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2024-1094 PERMISSION IS HEREBY GRANTED TO:
Project# windows 2024 Contractor: License:
Est.Cost: 6113 PATRICK KUBALA 100114
Const.Class: Exp.Date:09/09/2025
Use Group: Owner: HEON DAVID G&JOHN K HEON &CAROL HEON
Lot Size(sq.ft.)
Zoning: WSP Applicant: PATRICK KUBALA HOME IMPROVEMENT
Applicant Address Phone: Insurance:
5 PELL ST (413)589-1010 WCA1038596
LUDLOW, MA 01056
ISSUED ON: 08/27/2024
TO PERFORM THE FOLLOWING WORK:
4 replacement windows
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter: Footings:
Rough: Rough: House# Foundation:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driver ay Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
Fees Paid: $60.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
E rl Pe,rmr T To : ie >✓c r 1 y itU4ac a No.nE . Co rn
The Commonwealth of Massachusetts
FOR
��CI°
Board of Building Regulations and Standards Massachusetts State Building Code, 780 CMR EC' '' CIPALITY
Building Permit Application To Construct, Repair, Renovat= Or 10emc a Re` . ' .1 20. .
• One- or Two-Family Dwellingk i' -' v(7 -H Q
is Section For Official Use Onl. 1;F, 2°4'4
Building Permit Number:18/2,J-y !'O
f Date Applied o, eu
.n7
0 .S�p'11U
Building Official(Print Name) ,Jr_"�Signatuurre -*'`Da
SECTION 1:SITE INFORMATION !
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
t3 P driee.IC� .:// A
1.la Is this an accepted street?yes X no Map Number Parcel Number
1.3 Zoning Information: 1 1.4 Property Dimensions: •
Zoning District Proposed Use Lot Area(sq II) Frontage(II)
i
i 1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
I Required i Provided Required Provided j Required Provided
1
1.6 Water Supply:(M.G.L c.40.§54) 1.7 Flood Zone Information: 1 1.8 Sewage Disposal System:
Public D Private O Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if ves❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 er'of Record: /!
Name(Print) City.State,ZIP
No.and Street Telephone Email Address T
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building 0 1 Owner-Occupied ❑ rI Repairs(s) 0 i Alteration(s) 0 Addition 0
Demolition 0 I Accessory Bldg. 0 1 Number of Units ; Other 2( Specify:___ _
1 Brief Description of Proposed Work': �/AG 5'/ , G!6[-� !�(.�r`$ NJ v(A/S
1
•
• SECTION 4:ESTLMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ I. Building Permit Fee: S Indicate now fee is determined: !
0 Standard City;Town Application Fee ,
2. Electrical $ j 0 Total Project Cost3(Item 6)x multiplier x F
3.Plumbing $ ) 2. Other Fees: S
4.Mechanical (HVAC) 5 List:
5.Mechanical (Fire
Suppression) I
S Total All FAT
, ]�Check Amount` L t/ Cash Amount:
6.Total Project Cost: f S 6 //3, 0 0 1 0 Paid in Full 0 Outstanding Balance Due:
.SECTIONS: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
/v 0 i1 r/i/a.r—
"ArT weir fri( g License Number Expiration Date
Name of CSL Holder(Or homeowner if owner applying)
List CSL Tvpe(see below)
No.and Street Type ( Description
j0 � J 0� / ! Unrestricted(Buildings up to 35.000 cu.ft.)
City/Town,SNIP V Restricted 1&.'.Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
%'`/J 9/O/7 z y st.r 1 Y K N elli�l '1.(Op7� I j Insulation
Telephone em`ail address "' D ? Demolition
5.2 Registered Home improvement Contractor(HIC) ,,yam/ //3jJ
feed.6444 Adla mg r/17A,e0 yt alf N -IIC Registration Number Expiration Date
HIC IC o mpeny Name or HIC Registrant Name
No. d StreetGt L�.B A RJ J'T b eve r•4 ec.44Z .
Email address
ur I W g(4- D 1 O S ,cep-0,0
Citi/Town,State,ZIP Telephone •
IEON* RS'iCOMPEriSATION INSLRANCE AkkIDAVIT c.152.§ 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this a piication. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes No .
t "14,OWNERAUTTIORTZATION.TO BE COMPLETED WHEN
.-= j_` AGENT-OR CONTRACTOR APPLIES FOR BUILDLNG PERMIT
L as Owner of the subject property,hereby authorize 4Tr2.=CY 4-43.4 LA to act o:
behalf,in all matters relative to work authorized by this building permit application.
4, lrrd. c 4l C�
Print Owner's Name Signature Date
M. :� ; CTIOT 7bt'OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby arrest under the pains and penalties of perjury that all of the information contained in :his
application is true and accurate to the knowledge and understanding.
Print Owner's or Autho • Agent's Name &Signature 780 CMR RI05.3(6.) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor(not
registered in the Home Improvement Contractor(HIC)Program),will ligt have access to the arbitration program or guarar
fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at www.mass.gov•oca inform;
on the Construction Supervisor License can be found at www.mass.eov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basementiattics, decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number ofhalf/baths
Type of heating system `umber of decks;porches
Type of cooling system Enclosed Open
1 3. "Total Project Square Footage"may be substituted for"Total Project Cost'
Kubala Home Improvement
Your Window & Door Experts
34 Hubbard Street Ludlow, MA 01056
855-458-2252
Customer authorization for building permits.
I, Goa re 1 7.ean7 , as Owner of the property located at
.3(6 S9roc.e. 1-0 pAre- fig-tena ( dia9-phereby authorize Patrick Kubala Home
Improvement to act on my behalf, in all matters relative to attaining building permits, and
all matters relative to work authorized by such building permits.
6 r 7//2
Signature of Owner Date
KHI103
ai+y1,,,._ L MG l.L/LLLLILVLLIYCU[Lll of 1►ltsaaucILLLJCita
Department of Industrial Accidents
�. .pio Office of Investigations
_. �►= Lafayette City Center
2Avenue de Lafayette, Boston, MA 02111-1750
www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information - Please Print Legibly
Name (Business.'Organization:Individual): v, gAL/9 416 a e .jr1'PA,ierwe/tir""
Address: $y 144,„5004g 2 7--
City/State/Zip: .(4 jlow /l4 ?/P$ Phone ;#: 4//,3_,,f p/p i U
Are you an employer? Check the appropriate box: Type of project(required):
1.Cg 1 am a employer with 0 4• 0 I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees and have workers' y ❑ Building addition
[No workers' comp. insurance comp. insurance.:
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] ' c. 152,§1(4),and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
Homeowners who submit this affidavit indicating they are doing all v,ork and then hire outside contractors must submit a new affidavit indicating such.
1Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. /y�
Insurance Company Name: //2ex co/At/y-7-S �Ie.T/AA L i a 4 4Ai d C (::
Policy#or Self-ins. Lic. #: k'cd /4,3 J / Expiration Date: �6���aa?s�
Job Site Address:tie J7'/'UC�' , V/ Art CityrState/Zip: r'La' A'e4 /MA d Je 6
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verificati
I do hereby certify under the pains and pens tie perjury that the information provided above is true and correct,
Signature: Date:
Pls/.t li
Phone#: '174 -,f'd1 — 0/0
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Pertnit/License#
Issuing Authority(check one):
10Board of Health 20 Building Department 3EICity/Town Clerk 4.D Electrical Inspector S0Plumbing
Inspector 6.0Other
Contact Person: Phone#:
PATRKUB-CL LWONG
�....-- CERTIFICATE OF LIABILITY INSURANCE °ATE(NNUDDNYYYI
1 _ __ _ i 5/22/2024
THIS CERTIFICATE IS ISSUED 4 A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed,
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
this certificate does not confer r ghts to the certificate holder in lieu of such endorsement(sj.
PRODUCER faleCT Lori Wong
Smith Brothers Insurance,LLC PHONE FAX — —
300 Main Street WC,No,ma}:(608)499.5064 �.J! .No):
Oxford,MA 01540 Itlan Iwong@smithbrolhersusa.com
INSURER(S)AFFORDING COVERAGE NAIC I--_..._
_ INSURERA:Merchants Mutual Insurance Company- 23329 ,__
INSURED iimnfoLMAPFRE Insurance 23876
Patrick Kubala Home Improvements dba Kubala Home INSURER c
Improvements _ __.-�_� I
34 Hubbard Street INSURER D:
Ludlow,MA 01056-2762 I ti su*ER E:
INSURER F:
COVERAGES CERTIFICATE NUMUIiR: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR AWAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS.
DISC{iUBR -..._............._.-..-._... • POLICY EFF-, POLICY EXP 1
TYPE OF INSURANCEEN80}wtro POLICY NUMBER 4watonmai jandigatnroi LIMITS
A X COMMERCIAL GENERAL LIABILITY t EACH OCCURRENCE !$ 1,000,000
1 CLAIMS-MADE X OCCUR BOP1109317 6/1/2024 . 6/112025 DmmGSEs rE TO Es RENTED ooburtsneel $ 500,000
PtiE6H
MEG EXP(Any one person) '$ 6,000
i PERSONAL&ADV INJURY 1$ Included
GENt AGGREGATE LSAT APPLIES PER is E GENERAL AGGREGATE t' _ '2,�,�
X POLICY I I JECT 1 1 LoC PRODUCTS•COMP)oP AGG 2,000,000
I !
OTHER'. ' I '$
AUTOMOBILE uASIUTY -- - ; �INGLE LIMIT $
1, ,
I ANY AUTO BOMM64 6/1/2024 6/1/2025
_.__. ..__ I LBOOtLY IN./URY�tir person) !$
AAUTOS ONLY X 1'
SODILYRNJURYIeocWM3.�
e �.__------
--- Rip N�pp�y
AUTOS ONLY X WSW , ..� s irsiAGE
.:. .----.___.___..._......_._......___...
k S
A X 1 UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000
EXCESS LAB i CLMMS-MADE UP9151661 6/1/2024 6/1/2025 1,000,000
AGGREGATE.............................. ....�_
DED X RETENTIONS 10,000 f
$
A WORKERS COMPENSATION PER f OTH•
AND EMPLOYERS'LIABILITY Y J N SIAI.U..IE....�........_1...EF3______._
ANY�p�PROPREIETORIPARTNER:EXECCTIVE I ° CA1036596 6/1/2024 6/112025 1,000,000
EM ER/ME EXCLLDE09 NJA ! EL EACH ACCIDENT S-„_,,-,,,,-,_.___.____
IT describe under t -EA,_I�t_4c SE-EA EMPLOYEE $
1'�'
000
iDESCRIPTION OF OPERATIONS beim E.L.DISEASE-POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,AddIttonol Rsmuks Schocl M,my be attached If man owe Is raqurrndl
CERTIFICATE HOLDER CANCELLATION _ __- ..... .__.--_
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE
• HE EXPIRATION DATE THEREOF,Kubala Home Improvement,LLC TACCORDANCE WITH THE POLICY PROVISIONS.NOTICE WILL BE DELIVERED IN
34 Hubbard Street
Ludlow,MA 01056 ---
AUTHORIZED, /� REPRRE�SEENTATIVE
Ant
U to JMq
ACORD 25(2016103) 0 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
0,,,
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DEBRIS DISPOSAL FORM
In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be disposed of in
s proptrly-licemsed solid waste-dispcsai-€eeility as defined by MGI.. c 111,.S 15GA.
The debris will be disposed of in:
l�lpo,rc #-
LOCATION OF FACILITY
Si of Applicant Date
AFFIDAVIT
As a result of the provisions of MGL c 40, S 54, I acknowledge that as a condition of
Building Permit Number all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly licensed solid
waste disposal.faciity, as defined by MGL c 111,S 150A.
-- . •---.S. thaS1 wih.no ifX.3hg Building Official (two months -
maximum)of the location of the solid waste disposal facility where the debris resulting from
the said construction activity shall be disposed of,and I shall submit the appropriate form for
attachment to the Building Permit.
87s/,1 V
Date Signature ermit Applicant
(PRINT OR TYPE THE FOLLOWING INFORMATION)
/ scl'j,LAt
Name of Permit Applicant
l O�iGte,� A' s �Ga +C L 2a &a/Tl•c-!''�
Firm Name, if any
Kubala Home Improvements
The Window & Door Experts
5 Pell Street Ludlow, MA 01056
855-458-2252
Kubala Custom Windows
Energy Star & Performance Data
Revised June 2019
OPTION MFG CODE U- or SHGC VT CR
_ 7 Omega-Tuff 52210A .24) .21 .48 47
Hi-R ' N2210A .25 .28 .52 47
Essential P2100A .30 .49 .60 55
Passive P2210A .25 .48 .59 46
KUBALA HOME IMPROVEMENT LLC
MA HIC#207481 All home improvement contractors and subcontractors engaged in home improvement
ii_
1 34 HUBBARD STREET contracting,unless specifically exempt from registration by Provisions of Chapter I42A
of the general laws, must be registered with the Commonwealth of Massachusetts.
Inquiries about registration and status should be made to the Director, Home
LUDLOW, MA 01056
Improvement Contract Registration, One Ashb rton Place, Room 13 n, MA
413-589-1010 02108(617)727-8598 .(k-ttk"1 4'1. a S
Submitted VVV"" y 4r�0 �'
To: col Heim .�,'
2 pr � Job Name: Re� � � l �_
Job location: Flanvp ep
Phone
IS ^ �Date q Estimator__ _
We h-reby submit specifications and estimates for work to be performed and materials to used: A
11101�t:1ll1 ilr.�rr �.� ,M:titer. ! •. • '.. �►/A • .. �►. s. . • l —.a
.. A f��'�\tom.i+ i �`a 4 ,AA L._ a A. � . t, ,l>t— . ' a1. t aumpr�� r: �d
tfo fL Ali is • 1. riw/.LA ►.tlr 1 0 : , a Ail '&.. /.,.. 0 1
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illli < VENZIL
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WORK SCHEDULE d/ POLAIll t 71 1OA 6 V►4A i , u M6 sank e 5 cos a 'i /' ,rtM. pe4,. 1
Contract • of c i ork or order the materials before the third day following the signing of this agreement,unless specified Coltujis r ,:'b,' :the wok on or 0
about .e Baring delay caused by circumstances beyond the contractor's control. The work will be completed by �_ late. owner hereby
acknowledges and agrees that scheduling dates are approximate and that such delays that are not avoidable by the Contractor including but not limited to strikes.Acts of God,
shortages of materials,accidents,and all other delays beyond the its control,shall not be considered as violations of this Agreement.
WARRANTY �7')
The contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of y fol owing completion and shall
comply with the requirements of this Agreement. In the event any defect in workmanship or materials, or damage caused by the Contractor,its subcontractors,employees or
agents, is discovered after completion of any job,including clean up,the Contractor shall at its own expense,forthwith remedy,repair,correct,replace or cause to be remedied,
repaired or replaced,such damage or such defect in materials and workmanship. The foregoing warranties shall survive any inspection performed in connection with the agreed-
upon work.
We opose hereby to furnish aterial and labor-complete in accordance with above specifications, for the sum of:
rJ dollars(SigIL3,..._ ).
Pay to t to be made as ows:
%( _ )upon signing contract; KUBALA HOME IMPROVEMENT LLC
%( )upon completion of 34 HUBBARD STREET
( )upon completion of LUDLOW, MA 01056 413-589-1010
%t (0I13 )shall be made forthwith upon n an Ce-a( MA HIC 207481
completion of work under thiscont ct. U Salesperson: ( � r 1
Notice:No agreement for home improvement contracting work shall require a down payment yeu,,I,
(advance deposit)of more than one-third the total contract price or the total amount of all
deposits or payments which the contractor must make,in advance,to order and/or otherwise Authorized Signature:
obtain delivery of special order materials and equipment,which ever amount is greater
Acceptance of Proposal: I have read both sides of this document and accept the prices,specifications and conditions stated. I understand that
upon signing, this proposal becomes a binding contract. You arc authorized to do the work as specified. Payment will be made as outlined
above. You the buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this
transaction. Sec notice of cancellation form for an explanation of this right. Please refer to the Notice of Cancellation that accompanies
this contract;contents of which arc referred to above and incorporated herein by reference.
DO NOT SIGN THIS CONT CT IF THERE ARE ANY BLANK SPACES
Signature 4 I�" ebryf✓_ Date Signature_ Date____
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